CITY OF ROCKFORD

BLOCK PARTY APPLICATION

NAME: _______________________________________________________________________

ADDRESS: ____________________________________________________________________

TELEPHONE NUMBER: ________________ DATE & TIME OF EVENT:________________

AREA TO BE BLOCKED OFF:____________________________________________________

_______________________________________________________________

TYPE OF EVENT:______________________________________________________________

_______________________________________________________________

The block party applicant must inform all property owners and residents whose property abuts the street on which the proposed block event is to be held of the block party application and obtain the signatures of the affected property owners and/or residents. Please see the attached sheet to provide the signatures and addresses of the affected property owners and residents.

Public Works __________

Fire __________

Sheriff=s Dept. __________